CASCADE was established in 1997 as a collaboration between the investigators of 22 cohorts of persons with well- estimated dates of HIV seroconversion (seroconverters). It is currently a network of epidemiologists, statisticians, virologists and clinicians from lead HIV institutions in 13 European countries, Australia and Canada. Seroconverters are enrolled into the individual cohorts locally and nationally and are typically followed up life-long. CASCADE's main aim is to monitor newly infected individuals, as well as those already enrolled in studies, over the entire duration of HIV infection. The main premise is that through pooling data we are able to address issues which cannot be reliably addressed from single studies alone. Our main objectives are to: estimate survival expectations and assess changes over time; assess the impact of adverse drug reactions on survival, particularly if therapy is started close to seroconversion, and monitor changes in the cause of death over time; examine any changes in the characteristics of the virus over time; determine the impact of transmitted resistance, virus subtype, and host genetic factors on response to therapy and clinical outcome; characterise the foci of recent HIV epidemics in Eastern Europe; characterise initial disease progression in new epidemic areas; examine the effect of co-infection on HIV disease and response to therapy; and develop new techniques to facilitate the co-ordination of HIV clinical research across European cohorts. Follow-up data from seroconverters are unique in providing information from an individual's initial contact with HIV as events can, therefore, be related to roughly the same fixed time point in their disease. Seroconverters thus provide a unique opportunity to study HIV throughout its whole infection period and also enable us to examine the characteristics of recently acquired HIV infection in the population and changes over time.
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